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21ST AVENUE MEDICAL PLAZA, P.C.

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Company Details

Name: 21ST AVENUE MEDICAL PLAZA, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Inactive
Date of registration: 28 Oct 2002 (23 years ago)
Date of dissolution: 09 Nov 2011
Entity Number: 2827479
ZIP code: 11229
County: Kings
Place of Formation: New York
Address: 2101 EAST 16TH ST 2ND FLR, BROOKLYN, NY, United States, 11229

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 2101 EAST 16TH ST 2ND FLR, BROOKLYN, NY, United States, 11229

Chief Executive Officer

Name Role Address
SAMIRA OVSHAEV Chief Executive Officer 2101 EAST 16TH ST 2ND FLR, BROOKLYN, NY, United States, 11229

National Provider Identifier

NPI Number:
1134256761

Authorized Person:

Name:
SAMIRA OVSHAEV
Role:
PHYSICIAN
Phone:

Taxonomy:

Selected Taxonomy:
208100000X - Physical Medicine & Rehabilitation Physician
Is Primary:
No
Selected Taxonomy:
208VP0000X - Pain Medicine Physician
Is Primary:
No
Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
7186456600

History

Start date End date Type Value
2004-11-03 2006-11-10 Address 8717 21ST AVE, BROOKLYN, NY, 11214, USA (Type of address: Chief Executive Officer)
2004-11-03 2006-11-10 Address 8717 21ST AVE, BROOKLYN, NY, 11214, USA (Type of address: Principal Executive Office)
2002-10-28 2006-11-10 Address 8717 21ST AVE, BROOKLYN, NY, 11214, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
111109000176 2011-11-09 CERTIFICATE OF DISSOLUTION 2011-11-09
081010002492 2008-10-10 BIENNIAL STATEMENT 2008-10-01
061110002650 2006-11-10 BIENNIAL STATEMENT 2006-10-01
050519001127 2005-05-19 CERTIFICATE OF AMENDMENT 2005-05-19
041103002383 2004-11-03 BIENNIAL STATEMENT 2004-10-01

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Date of last update: 30 Mar 2025

Sources: New York Secretary of State